Popliteal Artery Aneurysms

Publication Date: May 19, 2021

Table 1. Summary of Recommendations

1. We recommend that patients who present with a PAA are screened for both a contralateral PAA and an abdominal aortic aneurysm (AAA). ( 1 – Strong , B)
679
2. We recommend that patients with an asymptomatic PAA ≥20 mm in diameter
should undergo repair to reduce the risk of thromboembolic complications and limb loss. ( 1 – Strong , B)
679
For selected patients at higher clinical risk, repair can be deferred until the PAA has become ≥30 mm, especially in the absence of thrombus. ( 2 – Weak , C)
679
3. We suggest that for patients with a PAA <20 mm, in the presence of thrombus and clinical suspicion of embolism or imaging evidence of poor distal runoff, repair should be considered to prevent thromboembolic complications and possible limb loss. ( 2 – Weak , C)
679
4. For asymptomatic patients with a life expectancy of ≥5 years, we suggest open PAA repair, provided that an adequate saphenous vein is present. For patients with a diminished life expectancy, if intervention is indicated, endovascular repair should be considered. ( 2 – Weak , C)
679
5. We recommend that intervention for thrombotic and/or embolic complications of PAA be stratified by the severity of acute limb ischemia (ALI) at presentation. We recommend that patients with mild to moderate ALI (Rutherford grade I and IIa) and severely obstructed tibiopedal arteries undergo thrombolysis or pharmacomechanical intervention to improve runoff status, with prompt transition to definitive PAA repair. We recommend that patients with severe ALI (Rutherford grade IIb) undergo prompt surgical or endovascular PAA repair, with the use of adjunctive surgical thromboembolectomy or pharmacomechanical intervention to maximize tibiopedal outflow. Nonviable limbs (Rutherford grade III) require amputation. ( 1 – Strong , B)
679
6. We recommend that
patients who undergo open popliteal artery aneurysm repair (OPAR) or endovascular popliteal artery aneurysm repair (EPAR) should be followed up using clinical examination, ankle-brachial index (ABI), and DUS at 3, 6, and 12 months during the first postoperative year and, if stable, annually thereafter. In addition to DUS evaluation of the repair, the aneurysm sac should be evaluated for evidence of enlargement. If abnormalities are found on clinical examination, ABI, or DUS, appropriate clinical management according to the lower extremity endovascular or open bypass guidelines should be undertaken. ( 1 – Strong , B)
679
If compressive symptoms or symptomatic aneurysm sac expansion are noted, we suggest surgical decompression of the aneurysm sac. ( 1 – Strong , C)
679
7. We suggest that patients with an asymptomatic PAA who are not offered repair should be monitored annually for changes in symptoms, pulse examination, extent of thrombus, patency of the outflow arteries, and aneurysm diameter. ( 2 – Weak , C)
679

Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Popliteal Artery Aneurysms

Authoring Organization

Publication Month/Year

May 19, 2021

Document Type

Guideline

Country of Publication

US

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management

Diseases/Conditions (MeSH)

D000783 - Aneurysm, D000094682 - Endovascular Aneurysm Repair, D000094622 - Popliteal Artery Aneurysm

Keywords

Popliteal Artery Aneurysm

Source Citation

Farber A, Angle N, Avgerinos E, et al. The Society For Vascular Surgery Clinical Practice Guidelines On Popliteal Artery Aneurysms. J Vasc Surg, 2021. doi:10.1016/j.jvs.2021.04.040